Initiating an Enhanced Recovery Pathway Program: An Anesthesiology Department's Perspective

Christopher L. Wu, Andrew R. Benson, Deborah B. Hobson, Claro P io Roda, Renee Demski, Daniel J. Galante, Andrew J. Page, Peter J. Pronovost, Elizabeth C. Wick

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Enhanced recovery pathways (ERPs) for surgical patients may reduce variation in care and improve perioperative outcomes. Mainstays of ERPs are standardized perioperative pathways. At The Johns Hopkins Hospital (Baltimore), an integrated ERP was proposed to further reduce the surgical site infection rate and the longer-than-expected hospital length of stay in colorectal surgery patients.

METHODS: To develop the technical components of the anesthesia pathway, evidence on enhanced recovery was reviewed and the limitations of the hospital infrastructure and policies were considered. The goals of the perioperative anesthesiology pathway were achieving superior analgesia, minimizing postoperative nausea and vomiting, facilitating patient recovery, and preserving perioperative immune function. ERP was implemented in phases during a 30-day period, starting with the anesthesiology elements and followed by the pre- and postoperative surgical team processes. The perioperative anesthetic regimen was tailored to meet the goal of preservation of perioperative immune function (in an attempt to decrease surgical site infection and cancer recurrence), in part by minimizing perioperative opioid use.

RESULTS: After six months of exposure to all ERP elements, a 45% reduction in length of stay was observed among colorectal surgery patients. In addition, patient satisfaction scores for this cohort of patients improved from the 37th percentile preimplementation to >97th percentile postimplementation.

CONCLUSIONS: Development of an ERP requires collaboration among surgeons, anesthesiologists, and nurses. Thoughtful, collaborative pathway development and implementation, with recognition of the strengths and weakness of the existing surgical health care delivery system, should lead to realization of early improvement in outcomes.

Original languageEnglish (US)
Pages (from-to)447-456
Number of pages10
JournalJoint Commission Journal on Quality and Patient Safety
Volume41
Issue number10
StatePublished - Oct 1 2015

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Anesthesiology
Surgical Wound Infection
Length of Stay
Colorectal Surgery
Delivery of Health Care
Perioperative Care
Postoperative Nausea and Vomiting
Baltimore
Patient Satisfaction
Analgesia
Opioid Analgesics
Anesthetics
Anesthesia
Nurses
Recurrence
Neoplasms

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Wu, C. L., Benson, A. R., Hobson, D. B., Roda, C. P. I., Demski, R., Galante, D. J., ... Wick, E. C. (2015). Initiating an Enhanced Recovery Pathway Program: An Anesthesiology Department's Perspective. Joint Commission Journal on Quality and Patient Safety, 41(10), 447-456.

Initiating an Enhanced Recovery Pathway Program : An Anesthesiology Department's Perspective. / Wu, Christopher L.; Benson, Andrew R.; Hobson, Deborah B.; Roda, Claro P io; Demski, Renee; Galante, Daniel J.; Page, Andrew J.; Pronovost, Peter J.; Wick, Elizabeth C.

In: Joint Commission Journal on Quality and Patient Safety, Vol. 41, No. 10, 01.10.2015, p. 447-456.

Research output: Contribution to journalArticle

Wu, CL, Benson, AR, Hobson, DB, Roda, CPI, Demski, R, Galante, DJ, Page, AJ, Pronovost, PJ & Wick, EC 2015, 'Initiating an Enhanced Recovery Pathway Program: An Anesthesiology Department's Perspective', Joint Commission Journal on Quality and Patient Safety, vol. 41, no. 10, pp. 447-456.
Wu CL, Benson AR, Hobson DB, Roda CPI, Demski R, Galante DJ et al. Initiating an Enhanced Recovery Pathway Program: An Anesthesiology Department's Perspective. Joint Commission Journal on Quality and Patient Safety. 2015 Oct 1;41(10):447-456.
Wu, Christopher L. ; Benson, Andrew R. ; Hobson, Deborah B. ; Roda, Claro P io ; Demski, Renee ; Galante, Daniel J. ; Page, Andrew J. ; Pronovost, Peter J. ; Wick, Elizabeth C. / Initiating an Enhanced Recovery Pathway Program : An Anesthesiology Department's Perspective. In: Joint Commission Journal on Quality and Patient Safety. 2015 ; Vol. 41, No. 10. pp. 447-456.
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